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A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in th

Thomas-Jones, Emma; Lloyd, Amy; Roland, Damian; Sefton, Gerri; Tume, Lyvonne; Hood, Kerry; Huang, Chao; Edwards, Dawn; Oliver, Alison; Skone, Richard; Lacy, David; Sinha, Ian; Preston, Jenny; Mason, Brendan; Jacob, Nina; Trubey, Robert; Strange, Heather; Moriarty, Yvonne; Grant, Aimee; Allen, Davina; Powell, Colin

Authors

Emma Thomas-Jones

Amy Lloyd

Damian Roland

Gerri Sefton

Lyvonne Tume

Kerry Hood

Dawn Edwards

Alison Oliver

Richard Skone

David Lacy

Ian Sinha

Jenny Preston

Brendan Mason

Nina Jacob

Robert Trubey

Heather Strange

Yvonne Moriarty

Aimee Grant

Davina Allen

Colin Powell



Abstract

Background
In hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions.

Methods
This study will be conducted in two district and two specialist children’s hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process.

Discussion
This paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS.

Journal Article Type Article
Publication Date Jul 25, 2018
Journal BMC Pediatrics
Print ISSN 1471-2431
Electronic ISSN 1471-2431
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 18
Article Number 244
APA6 Citation Thomas-Jones, E., Lloyd, A., Roland, D., Sefton, G., Tume, L., Hood, K., …Powell, C. (2018). A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in the UK: Paediatric early warning system – utilisation and mortality avoidance– the PUMA study protocol. BMC Pediatrics, 18, https://doi.org/10.1186/s12887-018-1210-z
DOI https://doi.org/10.1186/s12887-018-1210-z
Keywords Paediatric-early warning systems; Track-and-trigger tools; Mortality; Patient safety; Quality improvement
Publisher URL https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-1210-z#article-info
Additional Information Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Copyright Statement
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.





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